Before Bariatric Surgery

After your appointment with the UAB Weight Loss Medicine Clinic, you will be scheduled to meet with one of our bariatric surgeons. The surgeon will review your medical and surgical history and decide if bariatric surgery is right for you. The surgeon also will explain the different types of weight-loss procedures, discuss the pros and cons of each, and help you choose a path for your weight-loss journey.

The two most common bariatric surgeries are sleeve gastrectomy and gastric bypass. Patients who want to have a sleeve gastrectomy will undergo an upper GI (gastrointestinal) procedure, also known as an esophagram. This involves drinking a special “contrast” liquid while X-rays are done, allowing the doctor to look at your esophagus, stomach, and swallowing function.

Patients who want to have a gastric bypass will undergo an upper endoscopy, or EGD, which allows the doctor to look inside the part of your stomach that will be bypassed. This is done to make sure that there’s nothing wrong with that part of your stomach, because once the gastric bypass is done, there’s no easy way to examine that part of your stomach in the future.

Depending on your overall health, past medical history, and/or the requirements of your insurance company, you also may need to see other medical specialists to be cleared for surgery.

To start, please watch a video about the Metabolic and Bariatric Surgery Program at UAB Medicine.

To qualify for the surgery, you must not use tobacco or other nicotine products for at least two months before the procedure and agree to never use them in the future. This includes cigarettes, e-cigarettes/vaping, chewing tobacco, and nicotine gum. If you use any of these products now, you‘ll need to quit and take two blood tests to prove that you’ve stopped for good.

Some patients may be required to have a psychological or psychiatric exam before being approved for surgery. All patients must go through nutritional and dietary counseling with our dietitians.

Before approving weight-loss surgery, some insurance companies require proof that the patient has been very overweight for 3-5 years. They usually want to see medical records showing the person’s weight. If there are no such records, some insurance companies will accept old photos showing that the person is very overweight. A simple letter from a doctor saying that the person is overweight isn’t enough.

The risk of complications and death from surgery increase with the weight of the patient and any related health problems. For this reason, we require certain patients to lose some weight before surgery, often 10% or more. The UAB Weight Loss Medicine Clinic can help patients achieve that.

Some insurance companies want to see that a person has tried to lose weight with a doctor’s help before they will approve weight-loss surgery. They may require you to try a special diet, overseen by a doctor, for 3-6 months. In most cases, this diet needs to have been tried within the last year, or it might not count. The diet should be one that teaches the patient to change bad food habits and exercise more, provides advice on what to eat, and involves regular visits with the doctor, often monthly. The doctor must provide records of your diet and progress.

It’s important to fully understand your insurance company’s requirements, because different companies ask for different things, and their requirements sometimes change. If you don’t follow their rules, they might not approve the surgery.

Meeting the insurance company diet requirements is usually the most time-consuming hurdle that patients must clear before being approved for surgery. In most cases, if a preoperative diet is required by your insurance plan, there are three options for meeting this requirement:

Doctor-supervised diet

Your own doctor can help you with this kind of diet, and it will include:

• Learning about food, how to change bad habits, and how to exercise
• Detailed directions – a simple list of foods to eat is not enough
• Monthly visits with your doctor. The doctor will need to write down everything done to help you (download a form that can be used for this).

Joining a program

You can learn about food and exercise by joining a program such as WeightWatchers (WW).

• You’ll still need to see your doctor every two months, and your doctor should make notes about you going to these classes and the progress you are making.
• Online classes don’t count. It needs to be an in-person program, and you must keep track of your attendance.

UAB Weight Loss Medicine Clinic

We recommend this option, because our doctors know a lot about food and health and have plenty of experience helping people prepare for weight-loss surgery. All patients are required to visit this clinic at least once before seeing the surgeon.

After you finish all of the steps required for surgery, the UAB Weight Loss Clinic will ask your insurance company for approval. If it is approved, we’ll call you to schedule the surgery, and you’ll visit our clinic one more time before the procedure. We’ll update your health history, possibly do some blood tests, have you sign some papers, and answer any questions you might have.

About 4-6 weeks before surgery, all patients must take a special class about food and eating. You’ll have to pay for this class, where you’ll learn about:

• A special diet that you must follow during the two weeks before surgery. This diet helps you lose weight and get ready for the operation. It has very little sugar and very few carbohydrates (carbs). Some people have a big liver due to being overweight, and this diet helps shrink it and makes the surgery easier.
• Special foods and protein drinks you’ll need to purchase and consume during the two weeks before surgery
• Steps for eating after surgery. We call these diet steps phase 1, phase 2, phase 3, and phase 4. You’ll also learn about foods that you can’t eat anymore and vitamins you need to take.